Graduate Medical Education Acute Care Patient-Centered Care Tools and Strategies
Hospital discharge is a complex process for patients, nurses, and physicians. However, it has been underemphasized in terms of physician training and allocation of institutional resources and time. To ensure the safety of patients when they leave the hospital, it is important to discharge patients in a careful, thorough, and patient-centered manner, but reality often does not match this ideal. Incorporating the patient’s perspective and concerns is a key component of a safe discharge, but traditionally this has been overlooked in the busy hospital setting. The Patient-Centered Discharge Curriculum, which was develop and implemented by a multi-disciplinary team at Johns Hopkins Bayview Medical Center, empowers patients to participate more fully with the medical team in their health care.
The IPR project goal was to initiate patient- and family-centered care (PFCC) rounds in a general medicine unit in an adult-care inpatient setting. The project initially followed and measured the performance of one service team practicing PFCC Rounds on a general internal medicine unit with the aim of studying the impact on patient, family, staff, and doctors-in-training satisfaction; unit costs; residents’ and unit efficiency; quality; and safety. Educational effectiveness and team performance in PFCC Rounds were assessed through the use of the PFCC Rounds observation checklist; written evaluations by students, residents and attending physicians; and student debriefing during focus group sessions. Participating nursing staff were debriefed to ascertain their perceived benefits and challenges associated with their rounding with the medical team. Debriefing patients and families following the rounds encounters provided additional insights into the patient/family experience and the value of patient/family engagement during rounds.
Effective clinician-family communication is essential in all healthcare settings, but particularly in acute care settings such as the intensive care unit (ICU). In the ICU, patients are usually unable to speak for themselves and family members become their surrogate decision-makers. The challenges are many. Information must be shared clearly so family members can understand the nature of their loved one’s illness, as well as the diagnostic and treatment plans under consideration by the ICU team. Beyond content, there is much more to convey – assurances that the doctor, nurse or social worker is truly listening and responsive, that their understanding goes beyond that of the disease per se and includes empathy for the patient’s and family’s situation and feelings, that the professionals caring for the patient seek to work together and with the family as partners on behalf of the patient’s best interests, and have the requisite competence to do so.
The primary aim of this project is to improve residents’ ability to disclose medical errors. Disclosure, the process of bringing to light an unintended outcome, is essential to the nature of the patient-physician relationship. In this project, we are using simulated patient encounters, on-line teaching, self-assessment, and observer assessment to introduce the learners to proper disclosure.
The patient-centered training project established, integrated patient-centered care teams of project faculty and nursing staff to direct residents on a dedicated patient-centered care ward. Dr. Frankel worked with project faculty, nurse teachers and hospital administration, with a focus on strategies for becoming successful change agents. Success of patient-centered care delivery will be determined by descriptive and patient-specific data.